IND Exemption, Preparation
and Maintenance
Bruce K. Burnett, PhD, RAC (US, EU)
Director, Regulatory Affairs
Duke University
1
Templates and Guidance

Best Practices Templates/Instructions


http://tiny.cc/d7bpt
Recorded Webcasts

http://tinyurl.com/8n34gr4
2
Part 1: IND Exemptions
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Definitions
Studies Using FDA Approved Drugs
FDA Regulations & Guidance on IND
Exemptions
FDA Review Process
Special Cases
Case Scenarios
3
What is a Drug?

A drug is anything that meets the definition of a
drug per the FD&C Act (201(g)(1)). . .
“. . .articles intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease in man or
other animals. . .”
“…a substance (other than food*) intended to affect the
structure or any function of the body”**
* Note: “… food used as such (only to provide taste, aroma or
nutritive value), or to affect the structure or function of the body,
other than by providing nutrition, is not a drug”
** Note: “…compounds administered to blunt or provoke a
physiological response or to study the mechanism of action or
metabolism of a drug.”
4
What is an Investigational Drug?



A drug that is not approved to be marketed in
the US
An approved drug that is not used according to
its approved label
Note: Practice of medicine allows a physician to
use any approved drug without prior regulatory
approval
5
IND Exemption Assessment

Is the drug investigational?



It is not approved in the US
It is not used according to the label (off-label)
If the drug is investigational and is used in a
clinical study, it is subject to 21 CFR 312

Note: Off-label use is common and allowed in the
practice of medicine and often may be the standard of
care
6
Test Article
Not approved in US for
marketing as a drug
Investigational Drug
Requires an IND
Approved in US for
marketing as a drug
Commercially Available Drug
Might Require an IND
On-label
IND not
required*
Off-label
It depends!
* Assuming no marketing application planned
IND Exemption Assessment


21 CFR Part 312.2(b) – IND Exemptions
FDA guidance document: “IND Exemptions for
Studies of Lawfully Marketed Drug or Biologic
Products for the Treatment of Cancer”


http://tinyurl.com/nqkbkd
FDA guidance document: “Investigational New
Drug Applications (INDs) - Determining Whether
Human Research Studies Can Be Conducted
Without an IND”

http://tinyurl.com/2g7z7kv
8
IND Exemption Assessment

21 CFR 312.2(b)(1): The clinical investigation of
a drug product that is lawfully marketed in the
United States is exempt from the requirements
of this part if all of the following apply:

(i) The investigation is not intended to be reported to
the FDA in support of a new indication for use nor
intended to be used to support a significant change in
the labeling for the product
9
IND Exemption Assessment
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(ii) . . .the investigation is not intended to support a
significant change in the advertising for the product
(iii) the investigation does not involve a route of
administration or dosage level or use in a patient
population that significantly increases the risks (or
decreases the acceptability of the risks) associated
with the use of the drug product
(iv) the investigation is conducted in compliance with
IRB and informed consent regulations
(v) the study is conducted in compliance with
regulations regarding promotion or distribution of
investigational drugs
10
IND Exemption Assessment
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Evaluate risks associated with the changes in:



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Patient Population
Route of Administration
Dose and dosing regimen
Drug Combinations
11
IND Exemption Assessment

Studies that generally are exempt:


Single-arm, phase 2 trials using marketing drugs to
treat a cancer different from that indicated in the
approved labeling and using doses and schedules
similar to those in the labeling
Combinations of drugs, or new routes or schedules
that have been described in the professional medical
literature
12
IND Exemption Assessment

Studies that are generally not exempt:


Studies involving substitution of a new agent of
unproven activity are generally not exempt in settings
where standard therapy provides a cure or increase in
survival
Initial studies in humans of changes in the schedule of
drug administration, new routes of administration or
novel combinations of drugs
13
IND Exemption Assessments

Modifications to the marketed drug


Low-risk modifications to the lawfully marketed drug
(e.g. over-encapsulation, changes to color, scoring or
size for blinding purposes) are generally acceptable
For modifications beyond what is listed above, FDA
should be consulted

Mechanisms to consult FDA will be discussed later
14
Question

Do you have to go to the FDA to get an IND
exemption?

YES

NO
15
Answer

No – the IRB can (and the investigator)


“because the assessment of risks involved in a
therapeutic procedure is an everyday part of the
practice of medicine, the individual investigator should
usually be able to determine the applicability of the
exemption (due to risk) . . .”
However, at any time the FDA can be asked if
the study meets the criteria for IND exemption.
16
Reasons to Go to FDA . . .



IRBs as part of multi-site studies may have
different conclusions as to whether a study is IND
exempt
Some funding sources (commercial and Federal)
may want FDA confirmation of IND exemption
status
You and your IRB disagree on the IND exemption
assessment
17
IND Exemption Assessment by FDA
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Formal process
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The protocol is submitted as part of a complete IND
The cover letter explains rational for IND exemption
The review is on a 30-day clock
Informal process
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Less work up front
Not all divisions will provide IND exemption
assessments outside of the IND review process
Not on a clock, but generally faster
18
IND Exemption Assessment by FDA
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IND cover letter



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State in the first paragraph that you believe the study
may be exempt
Restate the five exemption criteria and how/why you
meet them
Focus on safety (number 3 of exemption criteria)
Make sure that your IND application is complete in
case you are not exempt

IND applications covered later
19
IND Exemption Assessment by FDA
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Informal Process

Start with Pre-IND consultation contacts listed on FDA
CDER website

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http://tinyurl.com/kskl6e
For CBER, go to the Organizational Charts website

http://www.fda.gov/AboutFDA/CentersOffices/OrganizationCharts/ucm135943.htm

Click on the appropriate office that your IND would be
reviewed by, e.g.:



Office of Vaccines Research and Review
Office of Cellular Tissue and Gene Therapies
Contact appropriate Division Director or Project Officer
20
IND Exemption Assessment by FDA
21
IND Exemption Assessment by FDA
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Informal process

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Call or email contact and explain situation
Ask if they will review the study and determine
whether the study meets the IND exemption criteria
Email protocol for review
FDA typically responds within 2 weeks whether the
study meets the IND exemption criteria
Use the email response to support IND exemption
requests with IRB or other interested parties
22
Special Cases
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Endogenous Compounds
Live Organisms
Dietary Supplements
Food
23
Endogenous Compounds



Endogenous compounds (those naturally found
in the body)
Often used in challenge studies to evoke
physiological response, characterize a disease
or establish mechanism of action
These studies require an IND!

Note: Although there is no intent to treat or mitigate
disease, there is intent to affect the structure or
function of the body
24
Definition of a Drug

A drug is anything that meets the definition of a
drug per the FD&C Act. . .



“. . .articles intended for use in the diagnosis, cure,
mitigation, treatment, or prevention of disease. . .”
“. . . a substance (other than food) intended to affect
the structure or any function of the body. . .”
Note: this definition not limited to compounds intended
for therapeutic purpose
25
Live Organisms

Challenge studies with live organisms (viruses,
bacteria and fungi) administered to study
pathogenesis or host response require INDs

Note: Although there is no therapeutic purpose, there
is intent to affect the structure/function of the body
26
Dietary Supplements

Under the Dietary Supplement Health and
Education Act of 1994, a dietary supplement is
defined as a product taken by mouth that are
intended to supplement the diet and contain a
dietary ingredient

Examples include vitamins, minerals,
herbs/botanicals, amino acids, concentrates,
metabolites, extracts or combinations of these
ingredients
27
Dietary Supplements

Under DSHEA, a dietary supplement is not
considered a drug if the intended use for which it
is marketed is only to affect the structure or any
function of the body

(i.e., not intended to be used for a therapeutic purpose)
28
Dietary Supplements

Thus, the need for an IND in a study involving
dietary supplements is determined by intent


Structure/function study with no therapeutic intent,
then no IND is required
Examples of studies not requiring an IND:


Studying the effect of calcium on bone mass
Studying the effect of fiber on bowel regularity
29
Dietary Supplements


If the clinical investigation is intended to evaluate
the dietary supplement’s ability to diagnose,
cure, mitigate, treat, or prevent a disease, then
an IND is required
Examples of studies requiring an IND:



Effect of a dietary supplement on osteoporosis
Effect of a dietary supplement to treat chronic diarrhea
or constipation
Effect of a dietary supplement on depression or
cognitive decline
30
Food

Section 201(f) of the FD&C Act (21 U.S.C.
321(f)) defines a food as:




(1) articles used for food or drink for man or other
animals,
(2) chewing gum, and
(3) articles used for components of any such articles
Whether an IND is needed for a clinical study is
again determined by intent
31
Food

Food is considered to be a drug if it is intended
for use in the diagnosis, cure, mitigation,
treatment, or prevention of disease. . .


An IND would be required if used as part of a clinical
study
Food that is intended to effect the structure or
function of the body are not drugs, as long as
the intended structure or function effect derives
from the product’s character as a food; its taste,
aroma, or nutritive value

No IND needed for such a study
32
Food

A study of an edible product to support growth of
children


No IND is required
A study of the same edible product used to
assess the blocking the absorption of
carbohydrates in the gut


The product becomes a drug because the primary
purpose of consuming it has changed (no longer for
its taste, aroma, or nutritive value)
An IND would be required
33
Case Scenario #1



Investigator plans to do a trial to assess the
effectiveness of Vitamin D in the treatment of
depression
Vitamin D manufactured by company X is legally
marketed as a drug to treat osteoporosis
Vitamin D manufactured by company (Y) is
legally marketed as a supplement
34
Case Scenario #1

Is this a drug study subject to 21 CFR 312?

If yes, could the study be IND exempt?

Using Vitamin D from Company X?

Using Vitamin D from Company Y?
35
Case Scenario #1

In case of clinical studies using supplements the
need for an IND is determined by intent


Structure/function study – no IND required
Therapeutic study – IND required
36
Case Scenario #1

For IND exemption criterion

21 CFR 312.2(b)(1) – “the investigation of a drug
product that is lawfully marketed in the United States”
21 CFR 312.2(b)(1)
37
Case Scenario #2


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Drug A and Drug B are both FDA approved to be
given in a combination for the treatment of colon
cancer
An investigator wants to add Drug C to Drugs A
and B in colon cancer
Drug C is approved for treatment of breast
cancer
Trial design is Drugs A, B and C versus Drugs A
and B in colon cancer
38
Case Scenario #2

Is this study eligible for IND exemption?

What drug(s) is/are used off-label in this study?
39
Case Scenario #2



Yes, all drugs are approved and thus eligible for
an IND exemption
Drugs A and B are approved to be give in the
combination for this indication, but not approved
to be given in combination with Drug C
Drug C is neither approved to be given in the
combo with A and B nor approved for this
indication
40
Case Scenario #3



Investigator plans to study the structural and
functional changes that occur in the eye after the
exposure to ragweed
Ragweed extract is an FDA approved drug for
use in the skin prick test to diagnose allergy
Investigator plans to administer drops of the
extract in the eye
41
Case Scenario #3

Is this a drug study subject to 21 CFR 312?

If yes, could the study be IND exempt?
42
Case Scenario #3

Yes, this is a drug study (structure – function
study)

Yes, the study is eligible for IND exemption
43
Break
44
IND Preparation and Maintenance
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Definitions and Types of INDs
IND Format and Content
Forms
Filing and FDA Review Process
Other Types of INDs
IND Maintenance
45
Definitions


Sponsor is an individual, company, academic
institution, or other organization that takes
responsibility for and initiates a clinical
investigation
Investigator is an individual who conducts a
clinical trial - under whose immediate direction a
drug is administered or dispensed
46
Definitions


Sponsor-Investigator is an individual who both
initiates and conducts an investigation, and
under whose immediate direction a drug is
administered or dispensed
Commercial IND


Ultimate goal is to obtain marketing approval
Sponsor-Investigator IND (Investigator-Initiated
IND)

Primarily research-driven (goal is publication)
47
IND Format and Content
1. Form 1571 (cover sheet)
2. Table of Contents
3. Introductory Statement
4. General Investigation Plan
5. Investigators Brochure
6. Protocols
7. Chemistry, Manufacturing and Control Data (CMC)
8. Pharmacology and Toxicology Data
9. Previous Human Experience
10. Other Information
11. Biosimilar User Fee Cover Sheet
12. Clinical Trials Certification of Compliance
48
IND Content and Format

Usual IND types

FDA approved drug


Non-FDA approved drug from company


Use drug label to support IND
Letter of Authorization to support IND
Non-FDA approved drug; sponsor is manufacturer

Sponsor is responsible for all information
49
IND Content and Format

FDA Guidance on Content and Format of INDs


http://www.fda.gov/downloads/Drugs/.../Guidances/ucm074980.pdf
Introductory Statement and General Investigational
Plan




21 CFR 312.23(3)
Sections usually separated into Sections 3 and 4 in IND
as listed on Form 1571
This information usually derived from Protocol
Investigational Plan lists broad objectives and planned
duration of the proposed clinical investigation(s)

This section is updated in each year’s Annual Report
50
IND Content and Format

Investigator’s Brochure


21 CFR 312.23(5) (Content of IB)
21 CFR 312.55 (Requirements for IB)


IB not required if it is a Sponsor-Investigator IND and a single
site study
ICH E6 (Proposed content and format of IB)
51
IND Content and Format

Protocol



21 CFR 312.23(6) (Content of Protocol)
ICH E6 (Proposed content and format of protocol)
6.1 Protocol




More than one protocol can be submitted to IND
INDs are drug and indication specific, so multiple protocols
must all pertain to the same drug and indication
6.2 Informed Consent
6.3 Form 1572 & CV
52
IND Content and Format

CMC




21 CFR 312.23 (7)
Approved drug labeling, Letter of Authorization or
Sponsor provides information
Content of CMC section discussed later
Pharmacology and Toxicology Information


21 CFR 312.23 (8)
Approved drug labeling, Letter of Authorization or
Sponsor provides information
53
Letter of Authorization



This is a letter (amendment) from a sponsor or
company to their IND, IDE or DMF stating that
confidential information in their submission can
be used in support of your IND
Thus, the FDA has “permission” to reference the
named submission to access information as part
of the review of your IND
A copy of the amendment is included in your
submission in the appropriate section of the IND
(CMC, Pharm/Tox)
54
Letter of Authorization




Required for all non-approved drugs unless
sponsor is providing necessary information
It is not required for FDA-approved drugs, even
if drug manufacturer has an open IND
It is not necessary to obtain permission of drug
manufacturer to use drugs in research studies
Research is also exempt of license/patent status
of drug
55
CMC Section

FDA Guidance on cGMP for Phase 1 Drugs


http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInf
ormation/Guidances/ucm070273.pdf
Drug Substance







Manufacturer
Raw Materials
Manufacturing Process
Analytical Testing (in-process and release)
Release specifications
Certificate of Analysis
Stability data and protocol
56
CMC Section

Drug Product








Manufacturer
Manufacturing Process
Analytical Testing
Specifications
Certificate of Analysis
Stability data and protocol
Container Closure
Labeling
57
CMC Section, Biologics

Components and Materials


Procedures


Cells, reagents, excipients
Preparation of MCB, WCB, final formulation
Product Testing

Sterility, mycoplasma, identity, contaminants,
endotoxin, potency, viability, cell dose/number
58
CMC, Biologics






In-process and release specifications,
Certificate of Analysis
Stability data, protocol
Container/Closure
Labeling
Guidance for Cell Therapy CMC

http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegula
toryInformation/Guidances/Xenotransplantation/ucm074131.htm
59
Pharmacology/Toxicology

Animal safety studies are required for IND
application (IND enabling toxicity studies)


Nonclinical safety studies must be done according to
Good Laboratory Practice (21 CFR Part 58)
ICH Guidance M3 lists nonclinical studies that must
be performed by phase of drug development


http://www.fda.gov/downloads/Drugs/GuidanceComplianceRe
gulatoryInformation/Guidances/UCM292340.pdf
LOA or drug label may be sufficient for this
section
60
Previous Human Experience


May not be any previous human experience if
drug is completely new
May be able to refer to published literature


Same indication
Different indication
61
Required Forms

1571


1572


Goes in Section 6.3 along with CV
3674


Goes in Section 1
Formerly placed in Section 10, now goes in Section
12 of new 1571
Obtain updated forms at FDA website

http://www.fda.gov/AboutFDA/ReportsManualsForms/Forms/defa
ult.htm
62
FDA Form 1571

Key Components

This is a legal commitment to comply with regulations
covering clinical trials conducted under IND


Instructions to fill out form found on FDA website:




“WARNING: A willfully false statement is a criminal offense”
http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Forms/
UCM182850.pdf
Must be submitted with each submission to your IND
Name of the Sponsor (person) who takes responsibility
for and initiates clinical investigation (Field 1)
For Sponsor-Investigator IND, the person should be
named and sign the form (Field 25)
63
FDA Form 1571

Key Components





If a pharmaceutical company will be supplying the
drug, but will not itself be submitting the IND (with that
protocol), the company is not the sponsor
The date of submission on the form (Field 2) should
match the date on the cover letter
The date of the Sponsor’s signature (Field 22) can be
different from the date of the submission (Field 2)
The order of the items listed in Field 13, Contents of
Application, should be followed in your IND
The form can be on separate pages
64
FDA Form 1571
65
FDA Form 1572

Key Components


Investigator is named in Field 1 and signs in Field 11
Contractual agreement between an Investigator, the
Sponsor and the FDA



“I agree to comply with all other requirements regarding the
obligations of clinical investigators and all other pertinent
requirements in 21 CFR Part 312”
“WARNING: A willfully false statement is a criminal offense”
Subinvestigators are listed in Field 6


These are individuals who will assist the investigator and make
a direct and significant contribution to the data
This section must be updated as needed and the amended
1572 submitted to the IND
66
FDA Form 3674


Certification of Compliance that all requirements
for registration of applicable clinical trials on
clinicaltrials.gov have been met
Field 9: Certification


Box A is checked if the clinical trial is not subject to
the registration requirements
Box B is checked if the registration requirements do
not apply at the time of the submission of the IND

Checked if it is an applicable clinical trial but the CT.gov
registration is not complete
67
FDA Form 3674

Field 9, Certification

Box C is checked if the study has been registered


Provide the National Clinical Trial (NCT) number
So if you have an applicable trial at the time of
submission, but have not registered, you can either:


Check B with the initial submission and the resubmit 3674
when you have an NCT number (checking C this time)
Or Check C with the initial submission and write ‘Pending’ in
the space for the NCT number

You will need to write “Pending” physically as the field will only
accept 8 digits
68
FDA Form 3674
69
FDA Form 3674

What clinical trials must be registered?

Applicable clinical trials are:




Interventional studies (drugs, biologics, devices)
Phase 2 – 4, Phase 1 drug safety studies are not required
US FDA jurisdiction (e.g., IND/IDE or US site)
Studies initiated after September 27, 2007, or initiated on or
before that date and were still ongoing as of December 26,
2007
70
FDA Form 3674


ICMJE requires public trial registration at time of first
patient enrollment if clinical data will be accepted for
publication
The Public Health Service Act requires registration
no later than 21 days after enrollment of the first
subject



Penalties up to a $10,000 fine for failing to submit or for
submitting fraudulent information to ClinicalTrials.gov
After notification of noncompliance, the fine may go up to
$10,000 per day until resolved
For federally funded grants, penalties may include the
withholding or recovery of grant funds
71
Filing the IND

Cover Letter





Dated the date of submission
Should summarize the content of your submission
May ask questions or ask for FDA comment on items
Important to list an alternate contact person
Submit original and two copies of IND



Less than 3 copies may result in delay of review
Typically original is in a grey ACCO-like report cover
2 copies are in different colors (other than grey)
72
Filing the IND

Where to send the initial IND application?

CDER (for drugs or protein therapeutics)
Food and Drug Administration
Center for Drug Evaluation and Research
Central Document Room
5901 Ammendale Road
Beltsville, MD 20705-1266
73
Filing the IND

Where to send the initial IND application?

CBER
Food and Drug Administration
Center for Biologics Evaluation and Research
Food and Drug Administration
1401 Rockville Pike, Suite 200N
Rockville, MD 20852-1448
Address to the Attention of the Division Director
74
IND Review by FDA

Sponsor receives acknowledgement letter with
IND number 10-14 days after submission



The letter contains the name of the project manager –
this will be your contact person for the IND
Save this letter
Approximately 7-10 days before decision, FDA
may contact sponsor if there are issues that
need to be resolved


Be available and respond quickly
You can email responses to FDA, but you need to
formally submit responses to IND
75
IND Review by FDA




By regulation, FDA must complete its review
within 30 days of receipt of the submission
If no issues are identified by day 30, the IND is
considered to be in effect (“approved”)
FDA does not routinely send a letter stating that
IND is in effect
This 30th day after receipt of the IND is your
‘effective date’

This date is important as the Annual Report is due
each year within 60 days (+/-) of this date
76
IND Review by FDA

The FDA’s primary objective in all reviews is to
ensure the safety and rights of subjects


All components of the IND maybe responsible for
safety concerns; the clinical protocol, the
manufacturing process/ drug product, or the
pharmacology toxicology data
To address FDA concerns, commitments in
writing may sometimes preclude a clinical hold


E.g., revise protocol, submit CoA for drug product, etc
This would be submitted as an amendment to the IND
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IND Review by FDA

If issues cannot be resolved within this 30 day
period, the FDA places the study (or IND) on
“clinical hold”


This will be communicated by phone or email by the
30th day
The official letter will listing the clinical hold issues will
arrive in approximately 30 days
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IND Review by FDA


FDA is not bound by a defined period of time to
review responses to clinical hold issues
When the clinical hold is lifted – the ‘effective
date’ is now the date on the letter from FDA
stating that you may now proceed
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Other Types of INDs

Single patient IND


Often referred to as ‘compassionate use’
This IND is used when patient cannot be enrolled in a
clinical trial for a variety of reasons:



Patient does not fit inclusion/exclusion criteria
Current protocols are no longer enrolling
Pharmaceutical industry has concerns as data from these
patients must be submitted as part of NDA/BLA review
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Other Types of INDs

Emergency Use IND




There is not sufficient time to submit IND prior to
giving drug to patient
Must contact FDA and get approval
IND is submitted as soon as possible
Treatment IND


Non-drug manufacturer opens IND to allow patient
access to drug during NDA/BLA preparation or FDA
review
Treatment protocol is opened under manufacturer’s
IND
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Maintenance of the IND

IND Amendments


Protocol, Information, Requests, Safety, Annual
Reports
Ending an IND



Inactivation
Withdrawal
Termination
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Maintenance of the IND
83
Maintenance of the IND

Protocol amendments




New protocol
Change in protocol
New investigator
Post Marketing Requirement/Post Marketing
Commitment (PMR/PMC)
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Maintenance of the IND

Protocol amendments – changes to an existing
protocol

A brief summary of the changes between the revised
protocol and previous version is a nice reviewer aid


It is not necessary to provide clean and tracked-change versions
The amended protocol is official as soon as it is received
at FDA



There is no defined review time for of amendments to the IND
However, if there are changes that could be construed as having
a safety impact, it is recommended that the sponsor hear from
FDA that the changes in the protocol are acceptable
IRB approval of the amended protocol is also required
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Maintenance of the IND

Protocol amendments – changes to existing
protocol

Exception


When a change is necessary to eliminate an apparent
immediate safety hazard to subjects, this can be implemented
without prior IRB or FDA review
Both IRB and FDA must be notified as soon as possible
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Maintenance of the IND

New investigator


The signed 1572 and CV of a new principal
investigator at a new site must be submitted to the
IND within 30 days of the site enrolling their first
subject
It is good regulatory practice for the sponsor to collect
the 1572, CV and IRB approval letter from the site
prior to shipping drug
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Maintenance of the IND

Information Amendments





Chemistry/Microbiology
Pharmacology/Toxicology
Clinical
Statistics
Clinical Pharmacology
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Maintenance of the IND

Information Amendments





Generally comprised of new technical information
Statement identifying the nature and purpose of the
amendment in the cover letter is recommended
Submit information amendments as needed but, if
possible, not more than once every 30 days
Amended 1572 forms can be submitted as clinical
amendments
You can bundle different types of amendments
in the same submission
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Maintenance of the IND – IND
Safety Reports

Types



Reporting requirements



Initial Written Report
Follow-up to a Written Report
Serious and Unexpected Adverse Events associated
with the use of the drug must be reported within a
defined period of time
The sponsor must notify the FDA and all participating
investigators
FDA Guidance:

“Safety Requirements for INDs….” Dec. 2012

http://www.fda.gov/downloads/Drugs/.../Guidances/UCM227351.pdf
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Maintenance of the IND
- IND Safety Reports

An SAE is any adverse drug experience
occurring at any dose that results in any of the
following outcomes





death
a life-threatening adverse drug experience,
inpatient hospitalization or prolongation of existing
hospitalization,
a persistent or significant disability/incapacity
a congenital anomaly/birth defect
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Maintenance of the IND
- IND Safety Reports

Unexpected SAE



Any event in which the specificity or severity of the
event is not consistent with the current investigator
brochure (IB), package insert or protocol
The assessment of relatedness/possible
relatedness to the use of the drug is made by
both the sponsor and the investigator
The investigator is responsible for reporting
unexpected SAEs to the IRB
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Maintenance of the IND
- IND Safety Reports

Reporting to FDA




Unexpected fatal or life-threatening AE must reported
within 7 calendar days
Serious and unexpected adverse drug experience
must be reported in 15 calendar days
New animal findings that suggest significant risk to
human subjects must be reported in 15 calendar days
Follow-up IND safety reports are submitted as
relevant safety information is available
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Maintenance of the IND
- IND Safety Reports

Reporting to FDA


IND safety reports are usually reported using the
MedWatch FDA Form 3500A
The sponsor (or FDA )may propose a different
reporting format and frequency for safety reporting

Must be approved in advance by FDA to be acceptable
94
Maintenance of the IND
- Annual Reports


Annual reports are due with 60 days of the
anniversary of the effective date of the IND
Content (21 CFR 312.33)







Individual Study Information
Summary Information (Safety)
Updated General Investigational Plan
Investigator Brochure (if changed)
Protocol Modifications (if not already submitted)
Foreign Marketing Developments
Outstanding Business
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Ending the IND

Withdrawal - Initiated by the sponsor


Inactive Status – Initiated by FDA or sponsor




If withdrawn for safety reason, IRB must be notified
Sponsor - at any time
FDA – if no subjects enrolled in 2 years, investigation
remains on clinical hold for >1 year or IND is inactive
for >5 years
INDs can be reactivated by submission of a new
protocol
As long as an IND is active, an Annual Report is
due
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Ending the IND

Termination – Initiated by the FDA


Based on safety issues, deficiencies in the IND or in
the conduct of an investigation
Rare occurrence, but FDA will do this if they feel
subjects in the study are at unacceptable risk
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Contact Information
bruce.burnett@duke.edu
98